Death within 8 days after discharge to home from the emergency department

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldBACKGROUND: Deaths within 8 days after discharge have, in previous studies, been evaluated retrospectively based on review of hospital records and the cause of death. The aim of the study was to evaluate the association of death within 8 days after discharge to home from the emergency department with a non-causative diagnosis in a prospective cohort study. METHODS: The records from the emergency department were filed by personal identification number and included information on gender, age, admission, discharge and diagnosis. The cause of death was obtained from a nation-wide registry by record linkage. Mortality per 100,000 within 8 days and the hazard ratio and 95% confidence intervals (CIs) were calculated for all causes of death in a time-dependent analysis. RESULTS: A non-causative diagnosis had been given to 11% of those who died within 8 days after discharge home. The mortality per 100,000 within 8 days was 208.5, within 15 days 347.4 and within 30 days 648.6. In the analysis of deaths within 8 days, the hazard ratio was higher for men than women and increasing age was significantly associated with high mortality. The hazard ratio for non-causative diagnosis was 0.44 (95% CI 0.20-0.96) as compared to causative diagnosis, adjusted for gender and age. CONCLUSION: The mortality rate within 8 days of discharge found in the present study is considerably higher than findings in previous studies. Death shortly after discharge of patients with non-causative diagnosis may indicate a misjudgement of the patients' condition at the time of discharge

Non-causative discharge diagnosis from the emergency department and risk of suicide

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldApproximately 20% of Emergency Department (ED) users discharged home receive a non-causative discharge diagnosis in the category of "Symptoms, signs, abnormal findings, and ill-defined causes," according to the International Classification of Diseases. The objective of this study was to evaluate the association of these non-causative discharge diagnoses with mortality in general and with violent death and suicide in particular. This is a prospective study; the primary source of data was computer records from the ED at Landspitali University Hospital, Hringbraut, Reykjavik, Iceland over the period 1995-2001. The main discharge diagnoses were recorded according to the International Classification of Diseases. Individuals with a non-causative discharge diagnosis were followed-up for cause-specific mortality through national registries by record linkage and were compared to national mortality rates and the rates of those with causative physical diagnoses. The standardized mortality ratios, hazard ratios, and 95% confidence intervals (CI) were calculated. The data on individuals with a non-causative discharge diagnosis from the ED revealed that the standardized mortality ratio for all causes was 1.57 (95% CI 1.39-1.77) among men and 1.83 (95% CI 1.61-2.08) among women. The hazard ratio for violent death was 1.64 (95% CI 1.07-2.52) and for suicide 2.08 (95% CI 1.02-4.24), adjusted for age and gender, among individuals with a non-causative discharge diagnosis compared to those having causative physical discharge diagnoses. Through analysis of the discharge diagnoses "Symptoms, signs, abnormal findings and ill-defined causes," this study has identified an association between the group of patients discharged from the ED with a non-causative diagnosis who are at high risk of suicide and who may, through further studies, become subjects for suicide prevention strategies

Seven-year evolution of discharge diagnoses of emergency department users.

To access publisher full text version of this article. Please click on the hyperlink in Additional LinkOBJECTIVES: To describe the pattern of main diagnoses of persons discharged home from the emergency department. METHODS: This was a descriptive study, using data from computer records of the emergency department at Landspitali University Hospital Hringbraut in Reykjavik, Iceland, over a 7-year period, 1995-2001. The main diagnoses of those discharged were registered according to the International Classification of Diseases and were transferred to the European shortlist, 'main categories'. Changes in the pattern of discharge diagnoses during the study period (1995-2001) were analyzed by calculating chi for the linear trend in each category. RESULTS: The proportion of users discharged each year increased through the period. In 1995, 54.5% were sent home (not admitted to hospital) and in 2001, 72.5%. Diagnoses in the diagnostic category 'symptoms, signs, abnormal findings, and ill-defined causes', were the most frequently applied to both men and women; this was the classification in more than 20% of cases on average. The most significant change during the study period was the increase in frequency of this category among both men and women. CONCLUSIONS: The proportion of emergency-department users, who are discharged without admission to hospital, increased and exceeded 70% of total cases received. On average, 20% of the discharge diagnoses were in the category 'symptoms, signs, abnormal findings, and ill-defined causes'. The pattern of discharge diagnoses can be assumed to reflect an increased load on the emergency department

Donner (Tim DuFore) clearing the mist, scene 4 of Das Rheingold, the first of the four operas of Wagner's Ring des nibelungen cycle, at the State Opera of South Australia 2004 [picture] /

Title devised by photographer and cataloguer from acquisition documentation.; Part of the collection: The State Opera of South Australia's production of Der Ring des Nibelungen.; Photograph signed and dated by photographer in pencil lower right.; Also available in an electronic version via the Internet at: http://nla.gov.au/nla.pic-vn4267533; Donated through the Australian Government's Cultural Gifts Program by Michael Scott-Mitchell, 2007

Risk of suicide and fatal drug poisoning after discharge from the emergency department: a nested case-control study

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVES: The objectives were to study the risk of suicide and fatal drug poisoning among emergency department users who had been discharged home, based on the main diagnoses selected by the emergency physician upon discharge. METHODS: This is a case-control study nested in a cohort of users of the emergency department who had been discharged. The cases of suicide (n=41) and fatal drug poisoning (n=21) were identified from the National Cause-of-death Registry, and five times as many controls were selected from users of the emergency department. Multivariate logistic regression analysis was used to calculate the OR and 95% CI adjusted for age and gender. RESULTS: Frequent visits to the emergency department were significantly associated with suicide and fatal poisoning. The study period spanned 7 years. The OR for suicide among cases and controls was 7.84 for those diagnosed as having mental disorders, 96.89 for those with use of alcohol, 24.51 for those with drug intoxication and 2.69 for those with a non-causative diagnosis. The OR for fatal poisoning for cases and controls was 12.26 for those with use of alcohol, 37.22 for those with drug intoxication and 5.76 for those with the classification category factors influencing health status. CONCLUSIONS: The clinical implication is that patients with any combination of previous main diagnoses of mental disorder, alcohol use, drug intoxication, a non-causative diagnosis or with the classification category factors influencing health status should be evaluated and assessed for potential risk of suicide or fatal drug poisoning